12/7/2023
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Posted by Provider Relations
Provider Access Online, Fidelis Care’s secure Provider Portal, gives your office access to many powerful tools. To learn more about the functionality available to you, please read below. Provider can also visit our Provider Access Online Resource page for additional information and instructional videos.
Provider Access Online User Roles
To fully benefit from Provider Access Online, it is important to grant the right access to your staff. The following represents the current available portal role options that can be added or removed from a user account:
- Account Administrator: Full access & user management role
- Authorizations Viewer: Access to view & create authorization requests
- Claims Information Viewer: Access to claims search functions
- Clinical Information Viewer: Access to view clinical data
- Patient Information Viewer: Access to search patient data
- Patient Roster Viewer: Access to review a patient roster (Primary Care)
- Remittance Advice Viewer: Access to downloadable remittance advice file
Confirm Patient Eligibility and Benefits
One of the most powerful features on Provider Access Online is the patient search tool. This feature allows providers and your assigned staff to check a patient's eligibility and benefits quickly and easily.
- Watch this informational video to learn how to navigate the patient menu, perform search functions, and review patient details:
- Please remember, a user needs Patient Information Viewer status to access this data after signing in.
To check a patient’s eligibility and benefits:
After signing in, click on Patient in the left navigational menu, and then select how you want to search for your patient. You can use any of the following search functions:
- Subscriber ID
- Medicaid ID/CIN
- Medicare ID
- Social Security Number
- Name and Date of Birth
Once you enter the requested information and the As-Of-Date, you will quickly see the Patient Details overview. Click on the patient’s name for full details, including Eligibility, Benefits, Patient Demographics, Primary Care Physician, and Authorizations.
Check Eligibility: Confirm the patient’s eligibility by product in the Eligibility section, including his/her effective date of coverage.
Check Benefits: The Benefits section provides a detailed, searchable list of the different services available to the patient, displaying important information such as covered benefits, network status, copayment, coinsurance, benefit limit, and deductible.
Locate and Review a Claims Status
Once logged in to the secure portal, use the menu on the left to navigate to the “Claims” screen.
- Select how you want to search for the claim from the drop-down menu. You can choose:
- Subscriber ID
- Claim ID
- Medicaid ID/CIN
- Medicare ID
- Patient Account Number
- Provider NPI
- Type the requested information in the selected field, enter the date range for the claims that you want to check, and click on Search.
- All claims for the date range that you selected will be listed, and the statuses of the claims are listed on the right.
- Click on an individual Claim ID for more information, including the Claim Summary, Payment Details, and Claim Line Items.
- Click on a Claim Line Item, and you will get full details on the item, including any reasons for disallowed claims.
Providers can also watch this informational video to learn how to navigate the claims menu, perform search functions, and review claim details.
Authorization Resources
With Provider Access Online, you can submit authorization requests to Fidelis Care or check the status of existing Fidelis Care requests.
- Provider can watch this informational video or reference the User Guide with step-by-step directions on how to request online authorizations and how to check authorizations status.
If you have any questions regarding the Provider Portal, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.